Pulmonary infections in immigrants and refugees.

Immigrants and refugees are susceptible to a wide array of pulmonary diseases, including familiar infections that are acquired after entry and unusual infections that are imported from abroad. The challenges are great; tuberculosis (TB) is now 13 times more prevalent among immigrants than among the general US population. Melioidosis, paracoccidioidomycosis, and paragonimiasis are often mistaken for TB. Pulmonary disease caused by parasites is uncommon and particularly perplexing unless a peripheral blood eosinophilia suggests helminthic infection. TB, melioidosis, fungal infections, and strongyloidiasis may remain inapparent for years and then produce devastating illness in the setting of immunosuppressive therapy or the acquired immunodeficiency syndrome. Proper health care of immigrants requires an understanding of unusual exposures and infections and should include preventive measures as well.